Intra-aneurysmal Wall Shear Stress Research Articles

Abstract TMP6: Computational Hemodynamic Analysis Of Intra-Aneurysmal Effects Due To Flow Diverter Stent Deployment Conformation

Introduction: Inflow blockage of aneurysms treated with flow diverter stents is dependent on the deployed braid angle (ϕ)—the angle between the yarns which comprise the stent braids and the longitudinal axis of the braid. We utilized computational fluid dynamic (CFD) analysis to examine the effects of braid angle on intra-aneurysmal hemodynamic parameters associated with long-term treatment success. Methods: Two flow diverter stents measuring 3.5 mm in diameter, each containing 88 strands with ϕ = 10° and ϕ = 35° were constructed and deployed into a patient model of an internal carotid artery saccular aneurysm containing pulsatile blood flow. Intra-aneurysmal flow velocity, pulsatility index (PI), turbulence, vorticity, and wall shear stress (WSS) parameters were obtained and compared for the two braid angles. Results: Reducing ϕ from 35° to 10° resulted in -2.59%, -1.92%, and -1.41% changes in systolic bulk velocity, and -1.79%, +0.57%, and -1.65% changes in PI at the aneurysm neck, body, and dome respectively. Vorticity changes were insignificant. High turbulence extending through the aneurysm neck peaked approximately 0.04 s later in systole, and was located closer to the parent vessel outlet when ϕ = 10°. Elevated intra-aneurysmal WSS was concentrated at the neck and body on the side of the parent vessel outlet for both ϕ = 10° and ϕ = 35°. Regions of WSS in excess of 10 Pa stretched higher into the aneurysm body when ϕ = 35°. Conclusion: Stenting at a lower ϕ resulted in higher blockage of flow and better reduction of WSS for initiating and facilitating long term intra-aneurysmal thrombosis. CFD analysis incorporating precise reconstruction of the stent deployment conformation into patient models can provide detailed visualization of flow parameters for assessing potential treatment efficacy throughout the diagnostic and treatment phases of patient care.

Cerebral Aneurysms Treated with Flow-Diverting Stents: Computational Models with Intravascular Blood Flow Measurements

Computational fluid dynamics modeling is useful in the study of the hemodynamic environment of cerebral aneurysms, but patient-specific measurements of boundary conditions, such as blood flow velocity and pressure, have not been previously applied to the study of flow-diverting stents. We integrated patient-specific intravascular blood flow velocity and pressure measurements into computational models of aneurysms before and after treatment with flow-diverting stents to determine stent effects on aneurysm hemodynamics. Blood flow velocity and pressure were measured in peri-aneurysmal locations by use of an intravascular dual-sensor pressure and Doppler velocity guidewire before and after flow-diverting stent treatment of 4 unruptured cerebral aneurysms. These measurements defined inflow and outflow boundary conditions for computational models. Intra-aneurysmal flow rates, wall shear stress, and wall shear stress gradient were calculated. Measurements of inflow velocity and outflow pressure were successful in all 4 patients. Computational models incorporating these measurements demonstrated significant reductions in intra-aneurysmal wall shear stress and wall shear stress gradient and a trend in reduced intra-aneurysmal blood flow. Integration of intravascular dual-sensor guidewire measurements of blood flow velocity and blood pressure provided patient-specific computational models of cerebral aneurysms. Aneurysm treatment with flow-diverting stents reduces blood flow and hemodynamic shear stress in the aneurysm dome.

The effect of aneurysm geometry on the intra-aneurysmal flow condition

IntroductionVarious anatomical parameters affect on intra-aneurysmal hemodynamics. Nevertheless, how the shapes of real patient aneurysms affect on their intra-aneurysmal hemodynamics remains unanswered.MethodsQuantitative computational fluid dynamics simulation was conducted using eight patients’ angiograms of internal carotid artery–ophthalmic artery aneurysms. The mean size of the intracranial aneurysms was 11.5 mm (range 5.8 to 19.9 mm). Intra-aneurysmal blood flow velocity and wall shear stress (WSS) were collected from three measurement planes in each aneurysm dome. The correlation coefficients (r) were obtained between hemodynamic values (flow velocity and WSS) and the following anatomical parameters: averaged dimension of aneurysm dome, the largest aneurysm dome dimension, aspect ratio, and dome–neck ratio.ResultsNegative linear correlations were observed between the averaged dimension of aneurysm dome and intra-aneurysmal flow velocity (r = −0.735) and also WSS (r = −0.736). The largest dome diameter showed a negative correlation with intra-aneurysmal flow velocity (r = −0.731) and WSS (r = −0.496). The aspect ratio demonstrated a weak negative correlation with the intra-aneurysmal flow velocity (r = −0.381) and WSS (r = −0.501). A clear negative correlation was seen between the intra-aneurysmal flow velocity and the dome–neck ratio (r = −0.708). A weak negative correlation is observed between the intra-aneurysmal WSS and the dome–neck ratio (r = −0.392).ConclusionThe aneurysm dome size showed a negative linear correlation with intra-aneurysmal flow velocity and WSS. Wide-necked aneurysm geometry was associated with faster intra-aneurysmal flow velocity.

Hemodynamics altered by placing helix stents in an aneurysm at a 45° angle to the curved vessel

Flow visualization, particle image velocimetry and numerical computation have been complementarily performed to study the fluid flow inside a stented lateral aneurysm. The curved afferent vessel had an inner diameter of 5 mm. The diameters of the aneurysmal orifice, neck and fundus were 7 mm, 5 mm and 7.5 mm, respectively, and the distance between the orifice and dome measured 10 mm. Stents with various porosities were examined. A volume-flow rate waveform of the internal carotid artery was reconstructed with a Wormersley number of 4 and Reynolds number ranging from 202 to 384 in a cardiac cycle. Results are presented in terms of the main and secondary flow velocity vector fields, the inflow rates into the aneurysm and the intra-aneurysmal wall shear stress and pressure. Some comparisons of the computed results with the experimental results and the data available from the literature are also made. It is found that the placement of stents for endovascular treatment is more critical for an unstented parent vessel with curvature than without since the maximum inflow rate of the former is 15 times the latter. The critical porosity of 70% below which an inhibition of intra-aneurysmal thrombus formation will not occur is identified for the first time.